Combining Procalcitonin and Calcitonin for the Diagnosis of Medullary Thyroid Cancer: A Two-Step Approach

IF 2.4 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Clinical Endocrinology Pub Date : 2025-06-04 DOI:10.1111/cen.15287

Cristina Clausi, Simona Censi, Emma Zanin, Giulia Messina, Ilaria Piva, Daniela Basso, Isabella Merante Boschin, Loris Bertazza, Francesca Torresan, Maurizio Iacobone, Fiammetta Battheu, Susi Barollo, Jacopo Maria Arnone, Caterina Mian

{"title":"Combining Procalcitonin and Calcitonin for the Diagnosis of Medullary Thyroid Cancer: A Two-Step Approach","authors":"Cristina Clausi, Simona Censi, Emma Zanin, Giulia Messina, Ilaria Piva, Daniela Basso, Isabella Merante Boschin, Loris Bertazza, Francesca Torresan, Maurizio Iacobone, Fiammetta Battheu, Susi Barollo, Jacopo Maria Arnone, Caterina Mian","doi":"10.1111/cen.15287","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>Calcitonin (CT) represents the most important biochemical marker of medullary thyroid cancer (MTC), but has certain limits. Procalcitonin (ProCT) has been recognized as an alternative or additional marker for MTC. The aim of the study is to evaluate prospectively the role of ProCT combined with CT in the identification of MTC.</p>\n </section>\n \n <section>\n \n <h3> Design</h3>\n \n <p><b>Patients and measurements:</b> 478 patients undergoing thyroidectomy in Padua between January 2023 and June 2024 were enrolled to investigate ProCT levels in comparison with CT for MTC diagnosis. Serum levels of ProCT and CT were dosed preoperatively.</p>\n \n <p><b>Results:</b> At histological diagnosis, 23/478 (4.8%) patients tested positive for MTC. CT with a cut-off > 10 pg/mL performed as follows: sensitivity 0.91, specificity 0.98, positive predictive value (PPV) 0.7, negative predictive value (NPV) 0.99. CT with a cut-off > 10 pg/mL performed better than ProCT both using the cut-off of 0.04 ng/mL (sensitivity 0.87; specificity 0.96; PPV 0.56; NPV 0.99) and the cut-off of 0.07 ng/mL (sensitivity 0.78; specificity 0.98; PPV 0.72; NPV 0.99). Within the sample of patients with a CT value between 10 and 100 pg/mL, 17/21 (80.9%) patients would have been correctly identified as MTC or non-MTC based on a positive or negative ProCT using the 0.04 ng/mL cut-off.</p>\n \n <p><b>Conclusions:</b> CT is more sensitive than ProCT as a diagnostic marker for MTC. However, a two-step approach using ProCT as a supplementary marker can help to refine the diagnosis avoiding overtreatment, particularly when CT serum levels lie between 10 and 100 pg/mL.</p>\n </section>\n </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"103 4","pages":"587-595"},"PeriodicalIF":2.4000,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.15287","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Endocrinology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/cen.15287","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

Calcitonin (CT) represents the most important biochemical marker of medullary thyroid cancer (MTC), but has certain limits. Procalcitonin (ProCT) has been recognized as an alternative or additional marker for MTC. The aim of the study is to evaluate prospectively the role of ProCT combined with CT in the identification of MTC.

Design

Patients and measurements: 478 patients undergoing thyroidectomy in Padua between January 2023 and June 2024 were enrolled to investigate ProCT levels in comparison with CT for MTC diagnosis. Serum levels of ProCT and CT were dosed preoperatively.

Results: At histological diagnosis, 23/478 (4.8%) patients tested positive for MTC. CT with a cut-off > 10 pg/mL performed as follows: sensitivity 0.91, specificity 0.98, positive predictive value (PPV) 0.7, negative predictive value (NPV) 0.99. CT with a cut-off > 10 pg/mL performed better than ProCT both using the cut-off of 0.04 ng/mL (sensitivity 0.87; specificity 0.96; PPV 0.56; NPV 0.99) and the cut-off of 0.07 ng/mL (sensitivity 0.78; specificity 0.98; PPV 0.72; NPV 0.99). Within the sample of patients with a CT value between 10 and 100 pg/mL, 17/21 (80.9%) patients would have been correctly identified as MTC or non-MTC based on a positive or negative ProCT using the 0.04 ng/mL cut-off.

Conclusions: CT is more sensitive than ProCT as a diagnostic marker for MTC. However, a two-step approach using ProCT as a supplementary marker can help to refine the diagnosis avoiding overtreatment, particularly when CT serum levels lie between 10 and 100 pg/mL.

Abstract Image

查看原文本刊更多论文

联合降钙素原和降钙素诊断甲状腺髓样癌：两步法。

目的：降钙素（CT）是甲状腺髓样癌（MTC）最重要的生化指标，但有一定的局限性。降钙素原（ProCT）已被认为是MTC的替代或附加标记物。本研究的目的是前瞻性评价ProCT联合CT在MTC鉴别中的作用。设计：患者和测量：2023年1月至2024年6月在帕多瓦接受甲状腺切除术的478例患者入组，研究ProCT水平与CT诊断MTC的比较。术前测定血清ProCT和CT水平。结果：在组织学诊断中，23/478（4.8%）患者检测出MTC阳性。截止阈值为10 pg/mL的CT：敏感性0.91，特异性0.98，阳性预测值（PPV） 0.7，阴性预测值（NPV） 0.99。CT的截止值为10 pg/mL，优于ProCT的截止值为0.04 ng/mL(敏感性0.87；特异性0.96;PPV 0.56;NPV 0.99)，截止值为0.07 ng/mL(灵敏度0.78；特异性0.98;PPV 0.72;NPV 0.99)。在CT值在10到100 pg/mL之间的患者样本中，17/21（80.9%）的患者可以根据0.04 ng/mL的ProCT阳性或阴性正确识别为MTC或非MTC。结论：CT诊断MTC的敏感性高于ProCT。然而，使用ProCT作为补充标记物的两步方法可以帮助改进诊断，避免过度治疗，特别是当CT血清水平在10至100 pg/mL之间时。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Endocrinology 医学-内分泌学与代谢

CiteScore

6.40

自引率

3.10%

发文量

192

审稿时长

1 months

期刊介绍： Clinical Endocrinology publishes papers and reviews which focus on the clinical aspects of endocrinology, including the clinical application of molecular endocrinology. It does not publish papers relating directly to diabetes care and clinical management. It features reviews, original papers, commentaries, correspondence and Clinical Questions. Clinical Endocrinology is essential reading not only for those engaged in endocrinological research but also for those involved primarily in clinical practice.